<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
    pageEncoding="ISO-8859-1"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Insert title here</title>
</head>
<body>
<div>
<form action="print.php" method="post" target="_blank">
<table width="23%" border="0" style="margin:20px;" >
  <tr>
    <td width="48%"><label>Date</label></td>
    <td width="52%"><input type="text" name="dDate" id="dDate"></td>
  </tr>
  <tr>
    <td><label>Bearer Name</label></td>
    <td><input type="text" name="BeareName" id="BeareName"></td>
  </tr>
  <tr>
    <td><label>Amount
        
    </label></td>
    <td><input type="text" name="num" id="num"></td>
  </tr>
  <tr>
    <td><label>Rupees</label></td>
    <td><input type="text" name="Rupees" id="Rupees"></td>
  </tr>
   <tr>
    <td></td>
    <td><input type="submit" value="Print" class="btn btn-large"/>&nbsp;<input type="reset" value="Reset" class="btn btn-large"/></td>
  </tr>
</table>

</form>
</div>

</body>
</html>